Highlights from Monday, January 27, 2020
Acne and Rosacea 2020
New drugs, new data, and new insights into acne and rosacea—Maui Derm’s esteemed faculty shared their insights into the management of acne and rosacea.
Lawrence Eichenfield, MD, presented on new therapies in acne. New therapies discussed by Dr. Eichenfield included trifarotene 50ug/g cream, which selectively targets retinoic acid receptor gamma. Research on trifarotene reviewed by Dr. Eichenfield showed significantly reduced inflammatory lesions on the face, back, shoulders, and chest compared to vehicle over the course of four weeks. Another treatment discussed was 4% minocycline foam, which demonstrated statistically significant reductions in inflammatory lesions, measured by a two-point or greater decrease in Investigator’s Global Assessment score. Clascoterone cream 1%, a first-in-class topical androgen receptor inhibitor, was also discussed, as well as a polymeric tazarotene 0.045% lotion, which Dr. Eichenfield reports performed better than the higher concentration tazarotene 0.1% cream, with fewer adverse events. Dr. Eichenfield also reviewed a treatment algorithm for acne fulminans and evolving research on the microbiome and acne.
Jim Leyden, MD, presented on isotretinoin dosing for severe acne. Dr. Leyden shared the algorithm he uses when treating with isotretinoin, starting all patients first on a topical retinoid plus benzoyl peroxide; if after 3 to 4 months suppression of inflammation is not achieved, Dr. Leyden moves on to spironolactone 100mg to 200mg per day and oral contraceptives, then isotretinoin for female patients. For male patients, he prescribes to the highest dose of isotretinoin that does not yield side effects until acne is cleared; if the patient relapses, Dr. Leyden restarts isotretinoin. For minor recurrences in most patients, Dr. Leyden refers back to topical retinoids and benzoyl peroxide.
Fernanda Sakamoto, MD, PhD, presented on devices for treating acne. Dr. Sakamoto reviewed photodynamic therapy (PDT) combined with red light, citing this as one of the most efficacious optical treatments for reducing acne by increasing the expression of TLR-2, which has been implicated in the inflammatory response against acne-related sebocytes, and reducing hyperkeratosis and sebum output. Dr. Sakamoto also reviewed common side effects to expect when treating acne with PDT, as well as developments in research on PDT from the past year.
Guy Webster, MD, PhD, reviewed how different strains of Propionibacterium acnes appear to affect inflammatory and non-inflammatory acne lesions. Dr. Webster also discussed topics related to isotretinoin therapy, including muscle damage, lab monitoring, rare instances of resistance to isotretinoin and lesions refractory to isotretinoin, bowel disease, bone mineral density during isotretinoin therapy, spondyloarthropathy, possible problems with muscle surgery, and male fertility. Dr. Webster went on to review adalimumab for hidradenitis suppurativa (HS), describing it as the most effective therapy for HS so far, as well as future therapies for HS, including ustekinumab and JAK inhibitors. New and emerging acne therapies discussed by Dr. Webster include topical minocycline, topical androgen inhibitors, sarecycline, encapsulated benzoyl peroxide, and photodynamic therapy. Dr. Webster concluded his presentation with an overview of new rosacea therapies, including brimonidine, topical minocycline, and encapsulated benzoyl peroxide.
Hot Topic—Regeneration 2020: The Science Beyond Rejuvenation
Wm. Philip Werschler, MD/FAAD/FAACS provided attendees with a presentation on the vast and exciting topic of regenerative medicine, which uses the body’s own repair and regenerative mechanisms to replace diseased or injured tissues, and its potential applications in aesthetic dermatology. The explosion of basic science research over the last decade in the areas of body rejuvenation is now being translated into dermatology. Dr. Werschler shared how the evolving science of “regeneration” will impact aesthetic and medical dermatology in the future. Topics discussed included:
- Defining biocellular medicine, identifying goals of biocellular medicine, and classifying therapies that fall into this category
- The evolution of regenerative therapy development
- An extensive explanation of PRP and its mechanisms of action in regenerative medicine
- Advantages to using PRP and the many ways in which PRP can be used in a regenerative dermatology practice—including hair restoration, microneedling, scar management, wound healing, aesthetic rejuvenation, and male and female sexual wellness